Dexamethasone vs. betamethasone for preterm birth: a systematic review and network meta-analysis

Agustín Ciapponi, Karen Klein, Daniela Colaci, Fernando Althabe, José M Belizán, Allie Deegan, Areti Angeliki Veroniki, Ivan D Florez
American journal of obstetrics & gynecology MFM 2021 January 19, : 100312

OBJECTIVES: To evaluate the comparative clinical effectiveness and safety of dexamethasone versus betamethasone for preterm birth.

DATA SOURCES: The sources searched were MEDLINE, EMBASE, Cochrane Library, LILACS, Clinical, International Clinical Trials Registry Platform without language restrictions until October 2019, along with reference lists of included studies. Field experts were also contacted.

STUDY ELIGIBILITY CRITERIA: Randomized or quasi-randomized controlled trials comparing any corticosteroids against each other or against placebo at any dose for preterm birth were included in the study.

STUDY APPRAISAL AND SYNTHESIS METHODS: Three researchers independently selected, extracted data, and assessed the risk of bias of the included studies by using EROS and COVIDENCE software. Random-effects pairwise meta-analysis and Bayesian network meta-analysis were performed. The primary outcomes were chorioamnionitis, endometritis/puerperal sepsis, neonatal death, respiratory distress syndrome and neurodevelopmental disability.

RESULTS: Forty-five trials (11227 women, 11878 infants) were included in the study. No clinical or statistical difference was found between dexamethasone versus betamethasone in neonatal death (odds ratio [OR] 1.05; 95% Confidence Interval [CI] 0.62-1.84; moderate-certainty evidence), neurodevelopmental disability (OR 1.03; 95%CI 0.80-1.33; moderate -certainty evidence), intraventricular hemorrhage (OR 1.04 95%CI 0.56-1.78); low-certainty evidence), or birthweight (+5.29 gr; 95%CI -49.79 to 58.97; high-certainty evidence). No statistically significant difference, but potentially clinically important effect, was found between dexamethasone and betamethasone in chorioamnionitis (OR 0.70; 95%CI 0.45-1.06; moderate-certainty evidence), fetal death (OR 0.81; 95%CI 0.24-2.41; low-certainty evidence), puerperal sepsis (OR 2.04; 95%CI 0.72-6.06; low-certainty evidence) and respiratory distress syndrome (OR 1.34; 95%CI 0.96-2.11; moderate-certainty evidence). Meta-regression, subgroup and sensitivity analysis did not reveal important changes regarding the main analysis.

CONCLUSIONS: Corticosteroids have proven effective for most neonatal and child relevant outcomes compared with placebo or no treatment for women at risk of preterm birth. No important difference was found on neonatal death, neurodevelopmental disability, intraventricular hemorrhage, and birthweight between corticosteroids, and no statistically significant but potentially important difference was found in chorioamnionitis, fetal death, endometritis/puerperal sepsis and respiratory distress syndrome. Further research is warranted to improve the certainty of evidence and inform health policies.

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